Suicides in Greece rose to their highest level in 30 years following the implementation of severe cost-cutting austerity measures in 2011, according to a new study. The findings, published today in BMJ Open, add to a growing list of concerns about the health impacts of major public spending cuts implemented throughout Europe following the global financial crisis.

The study examined trends in monthly suicide rates in Greece from 1983 to 2012 — a 30-year period marked by prosperous highs and tragic lows. After severe cuts were introduced in June 2011, suicides among both men and women increased by nearly 36%, the researchers found, and the number continued to rise throughout the rest of 2011, reaching an all-time high in 2012.

Suicide rates in Greece and much of southern Europe have historically been low compared to other developed countries. But a 2011 study found that rates have increased across Europe following the financial crisis, especially in hard-hit Greece.

In 2010, the Greek government began rolling out a series of controversial measures that would raise taxes and cut billions in public spending, sparking widespread protests and strikes. The severe cost-cutting also left its public healthcare system under considerable strain, prompting closer studies of its health-related impacts. In 2014, researchers found a direct link between spending cuts and increased suicide rates among Greek men, calculating that at least 551 men had taken their lives “solely because of fiscal austerity” between 2009 and 2010. A 2013 study found a similar connection in Spain following the financial crisis.

The study released today is the first to link monthly suicide data over multiple decades to specific austerity-related events. To reach their conclusions, the researchers monitored changes in monthly suicide totals following 12 highly publicized events: eight austerity-related and four prosperity-related. The study design — called an interrupted time-series analysis — allowed the researchers to examine how these events impact suicide rates.

A total of 11,505 people took their own lives between 1983 and 2012 — 9,079 men and 2,426 women. The analysis revealed that suicide rates began to rise slightly in 2008, when the economic recession first took hold. Austerity measures were introduced in June 2011 and coincided with an increase in suicides of over 35.5% – an average of an extra 11.2 suicides a month – which was sustained all the way into the following year. No other events were associated with such a dramatic shift in reported suicides.

“Relative to other months in which a new series of austerity measures were passed by the Greek government, June 2011 may have been most significant because it was the first part of a larger austerity plan that passed by a very narrow vote,” the researchers suggest. “This passage occurred despite polls suggesting that the vast majority of the Greek public were opposed to the austerity plan.”

Economic instability primarily affected men who were the main family income generators compared with women, the authors say. However, suicides among women also increased alongside events associated with austerity, with an increase of just under 36% occurring in May 2011. Again, this increase was sustained until 2012.

The researchers found that the overall pattern of suicides rising after an austerity-related event held even after adjusting for the misclassification of suicide. As they explain in their paper, suicides are significantly underreported in Greece, and are often misclassified, either intentionally or unintentionally, as accidental deaths. Intentional misclassifications are usually done so the family can avoid the stigma associated with suicide. In addition, the Greek Orthodox Church considers suicide a sin and does not permit people who take their own lives to be interred with a burial service.

The findings show that drastic cost-cutting measures are not harmless, the authors say, and that policymakers should ensure that mental health is a priority during times of austerity. “As future austerity measures are considered, greater weight should be given to the unintended mental health consequences of these measures,” they write.

The media’s role in suicide prevention

The researchers say public awareness and adequate mental health services are key, though the media also has a role to play in suicide prevention. According to the analysis, male suicides briefly jumped by 30 percent after a Greek pensioner publicly committed suicide in April 2012. The event received widespread coverage and, as the study notes, was reported in ways that could promote copycats: details of the man’s life, his method of suicide, and quotes from a note he left behind. Interestingly, one prosperity-related event — the adoption of the euro currency in January 2002 — preceded a sharp but temporary 27 percent decrease in male suicides.

“We found that perhaps it is the economic policies themselves, but also the public messaging of these policies that are both driving the changes in suicide,” Dr. Charles Branas, an epidemiologist at the University of Pennsylvania and lead author of the study, told AFP.

“Greater attention should be paid to the public reporting of austerity measures and any subsequent suicide-related events that may follow,” the authors conclude. An important task, adds Dr. Branas, “is to think about different, less ominous messaging when austerity policies are enacted and perhaps even to consider less drastic policies that achieve similar goals.”

Of course, this study demonstrates only a correlation between austerity-related events and a rise in suicides in Greece; it does not prove causation. While the researchers controlled for changes in population, demographics, unemployment, and other variables, they acknowledge that the difficulty in isolating the impact of a single event. The pensioner’s public suicide, for example, happened during the same month as the announcement of national elections, heightening political and economic tensions.

The protective role of social programs

Past research certainly supports the idea that robust social programs can buffer the effects of hard economic times — and that cutting back on such programs can lead to tragic outcomes. In a 2014 study published in the British Journal of Psychiatry, researchers found that the economic downturn that began in 2007 resulted in at least 10,000 additional suicides in the U.S., Canada, and Europe between the years of 2008 and 2010.

However, despite the overall increase, suicide rates didn’t climb evenly. In some countries, like Sweden and Austria, suicide rates remained flat during the Great Recession, even though those nations’ economies struggled as much as others did. The difference, said the researchers behind that study, is that Sweden and Austria had strong social programs to help people who lost their jobs or were struggling financially.

Another 2014 study, published in the International Journal of Epidemiology, reported similar results, finding that American workers may be at higher risk for major depressive disorder after job loss than European workers. The researchers attributed that finding to the fact that America’s unemployment benefit programs are less comprehensive than those offered by their European counterparts.

Most recently, a study published in the journal Social Forces found a positive association between government spending on social services and the happiness of that country’s population — meaning that that people who live in countries that spend more on social services are happier than those living in countries that spend less.

While Greece’s suicide trends are worrisome — and its short-term economic outlook remains grim — its politics have changed dramatically as a result of last month’s elections. With the Syriza party now in government and pledging to end austerity measures in the country as their first act of governance, many are hopeful that the country will see an improvement in its collective well-being as well as its economy.